4. The enterprise concept. Years ago, when radiologists discussed "the enterprise," the term referred to anyone outside the department who still worked within the hospital's firewall. But as health systems have expanded and more specialties have become image producers and consumers, the definition of "enterprise" has expanded, Chang said. Radiology groups have consolidated, many facilities within the same system are separated by hundreds of miles, and providers are now required to read scans for multiple hospitals.
The logistics of moving images from one facility to another aren't difficult — the real challenge comes in coordinating the workflow needed to properly use transferred scans. According to Rasu Shrestha, MD, MBA, a University of Pittsburgh Medical Center radiologist, however, the potential exists, for EI to have a significant positive impact on work flow management.
"[EI] allows for a patient-centric approach to care versus an image- or application-centric approach," he wrote in a 2012 Applied Radiology article. "It allows for the possibility of true collaboration among care teams, which would bring the value of imagers back into the spotlight."
5. Tying it all together. The real challenge behind effective EI, Chang said, is to fuse the needed technology with the proper workflow perspectives. But it can be helpful, he said, to consider that EI is less about imaging and more about radiology's need to re-invent itself as healthcare enters a new chapter of value-based purchasing.
"The concept of enterprise imaging is a proxy or code word for having to re-engineer a more useful, comprehensive workflow solution for a more complex enterprise," he said. "It's better not to talk about enterprise imaging but talk about re-engineering ourselves so we can continue to add value."
How can you plan?
It's no longer a question of whether EI is right for your practice or department. Radiology's move toward EI is clear, and it's up to you to determine how you will navigate these new waters. There are many moving parts with this imaging strategy, Chang said, but you can outline your course of action by remembering one question: "What is the role of radiology or the radiologist in this decision?"
For example, as the end-user, you can — and should —tell your IT department what you need out of a VNA, but don't expect to be included in any purchasing decisions. The facility's chief financial officer and chief information officer will make that determination, he said.
You will, however, have a greater role — alongside cardiologists and other providers — in determining how the VNA architecture will support your needs and workflow. In addition, you must make it clear to your hospital administrators and IT department that any EI system must offer interoperability for the strategy to succeed, said Robert Barr, MD, president of Mecklenburg Radiology Associates in Charlotte, N.C.
Through interoperability, he said, his practice — which has been using EI for several years — is able to quickly migrate images between all subspecialties, streamlining patient care and facilitating greater access to patient records.
Your biggest role, however, will be in providing evidence that supports the true value you bring to your facility. Your worth is no longer tied solely to the number of interpretations you produce daily, Chang said. You must now demonstrate your impact on patient outcomes, population management, and down-stream resource utilization and cost control.
"In the fee-for-service environment, we could be selfish and insular in our thinking. We floated everyone else's boat," he said. "But now we're a cost center, and every CT you order better be worth it. Justify it, and demonstrate its positive impact."